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Primary endpoints were overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRRFS). Kaplan-Meier estimates, multivariable Cox regression models, and a\u00a01:1 matched-pair analysis were applied. Residual confounding was quantified using E\u2011values.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohorts were well balanced, except for a\u00a0higher prevalence of HPV-negative tumors (52% vs 42%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.004) and ECOG performance status &gt;\u202f1 (20% vs 9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.004) in secondary hospitals. Median follow-up was 34\u00a0months. OS (median 35.5 vs 32\u00a0months; HR 0.90, 95% CI 0.72\u20131.12) and PFS (29 vs 21.5 months; HR 0.86, 95% CI 0.69\u20131.07) did not differ significantly between groups. LRRFS was shorter in secondary hospitals (32 vs 25.5 months; HR\u00a01.25, 95% CI 1.06\u20131.48;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.05), which may partly be explained by the higher rate of HPV-negative tumors in this cohort. Sensitivity analyses indicated that residual confounding may still have contributed to this difference. Multivariable analysis identified ECOG &gt;\u202f1 (HR 3.29), HPV negativity (HR 2.56), R2 resection status (HR 16.1 for PFS), and a\u00a0cumulative cisplatin dose &lt;\u202f160\u202fmg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (HR &gt;\u202f3) as independent prognostic factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Radiotherapy for pharyngeal and laryngeal cancer achieved comparable OS and PFS in tertiary and secondary hospitals that adhere to current quality benchmarks. The observed difference in locoregional control, which was limited to the primary (non-surgical) cohort, is consistent with the higher proportion of HPV-negative and functionally impaired patients treated in secondary hospitals. Residual imbalance after adjustment and matching indicates that unmeasured clinical or treatment-related factors may also contribute. Prompt initiation of RT and adequate cumulative cisplatin dosing remain critical.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-026-02550-z","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:12:36Z","timestamp":1778519556000},"page":"1037-1047","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multicentre patterns-of-care analysis of adjuvant and definitive (chemo)radiotherapy for pharyngeal and laryngeal carcinoma in Franconia, Germany"],"prefix":"10.1007","volume":"202","author":[{"given":"Karoline","family":"Pollmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Salazar Hammann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Willner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinhart","family":"Sweeney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"M\u00fcnch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gehrke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Flentje","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Wittig-Sauerwein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9146-3083","authenticated-orcid":false,"given":"Victor","family":"Lewitzki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"2550_CR1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.radonc.2009.04.014","volume":"92","author":"JP Pignon","year":"2009","unstructured":"Pignon\u00a0JP, le Ma\u00eetre\u00a0A, Maillard\u00a0E, Bourhis\u00a0J, MACH-NC Collaborative Group (2009) Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. 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